Individual
KRAIG SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6206
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6206
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2438-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2438-23
WI LICENSE
WI
Enumeration date
06/18/2009
Last updated
06/18/2009
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